Friday, May 9, 2014

Hypoactive
Sexual Desire Disorder (HSDD) is an absence of sexual fantasies and desire for
sexual activity.

Absent
or diminished feelings of sexual interest or desire, absent sexual thoughts or
fantasies, and a lack of responsive desire. Motivations for attempting to
become sexually aroused are scarce or absent. The lack of interest is
considered to be beyond a normative lessening with life cycle and relationship
duration.

Causes
for Hypoactive Sexual Desire Disorder (HSDD)

The individual

Psychological
risk factors in the individual can be expressed within the context of sexual
intimacy, giving rise to the development of HSDD. These involve:

Anxiety;

Depression;

Sexual
orientation conflicts;

Negative
thinking patterns;

Inaccurate
beliefs about sex;

Poor
body image;

A
tendency to fuse sex and affection;

Career
overload; and

Related
sexual problems.

Fears
can also increase the risk of developing HSDD, since emotional and physical
intimacies are closely related.

Sexual
desire may be hampered by a fear of intimacy, anger, rejection and abandonment,
exposure, feelings or dependency.

Physical
factors, such as sexual abuse and emotional trauma, can also inhibit desire.

Inter generational risk factors - Family
of origin

Many
anti-sexual beliefs are learned within the social familial context. For
example, when raised in an extremely religious household, an individual may
learn that sex is for procreation and not personal enjoyment. This can lead to
feelings of guilt and shame, and may then result in HSDD.

Interactional risk factors - The couple’s
relationship

The
extent to which an individual is satisfied with a marriage or relationship is
related to sexual satisfaction. For example, women with HSDD tend to report
greater degrees of marital distress and less relational cohesion.

Other
relational risk factors can include:

Contemptuous
feelings;

Criticism;

Defensiveness;

Power
struggles; and

Toxic
communication.

Medical aspects

Deficiencies
of testosterone or other hormones, and medical conditions that create hormone
deficiencies, can have an impact on sexual desire. Chronic medical conditions,
physiological changes, and medications can also contribute to HSDD.

This
includes:

Depression;

Medications,
such as serotonergic antidepressants;

Chronic
debilitating illnesses, such as chronic renal failure;

Fluctuations
in blood sugar with diabetes; and

Hyperprolactinaemia,

Hypo
and Hyperthyroid states this is less common.

Arousability may also be negatively
affected by:

Androgen
deficiencies;

Lamic
or pituitary disease; and

Prolonged
high-dose steroid use.

Symptoms of Hypoactive Sexual Desire
Disorder (HSDD)

HSDD
can be either lifelong or acquired.

When
HSDD is lifelong, the absence of sexual desire is a typical state for the
person.

Acquired
HSDD occurs when a change is experienced in sexual appetite.

An
individual with a generalized lack of desire does not have a sexual
appetite under any circumstances.

On
the other hand, an individual who experiences selective desire in certain
situations or with specific partners is classified as situational type.
For example, a person might feel desire toward a partner they have an
affair with, but not with their established partner.

It
is important to note that males with inhibited sexual desire appear to use
fantasy in a different way to females with this complaint.

Females
with desire phase problems show low levels of fantasy, whereas men with
desire phase problems show a high level of sexual fantasy.

Males
may use sexual fantasy to enhance their sexual performance due to response
anxiety.

Response
anxiety is experienced when there is widespread pressure to feel sexually
aroused, but arousal does not occur.

Sexual
fantasies may be constructed to help generate sexual arousal that is difficult
to achieve without the use of fantasy.

Clinical Findings of Hypoactive Sexual
Desire Disorder (HSDD)

Clinical
assessment of HSDD should take into account a variety of factors related to the
individual and the couple, including:

Level of emotional intimacy;

The
belief that emotional intimacy is highly relevant to the experience of sexual
desire is not new.

Mental and physical health

Assessment
and management of overall mental health is vital, as is assessment of
well-being at the time of sexual interaction. This includes energy levels,
self-esteem, sense of attractiveness, body image, and freedom from stressful
distractions and preoccupations.

Depression
is strongly associated with reduced sexual function. Antidepressants,
especially those that are highly serotonergic, may lessen sexual desire.
Various medical conditions can also impact on a person’s level of desire.

Sexual context

A
detailed assessment of a couple’s usual sexual context may lead the health
professional to recommend changes. Factors that may be assessed include:

Time
of day;

Time
since last sexual activity;

What
happens in the hours preceding sexual opportunities; and

What
needs to be done after sexual activity.

The couple Relationship issues or
concerns;

Throughout
the assessment process, the health professional will evaluate the couple’s
emotional contracts, styles of communication, level of discord, conflict
resolution style, and ways of defining problems.

When
evaluating emotional contracts, the health professional will look at what is
important for the couple to feel good emotionally, i.e. what is needed and what
they do to feel happy. Western philosophy and psychology generally agree that
happiness is good for people and distress is bad, that people seek happiness,
and that it is easier to be happy when others are happy as well. To attain such
conditions, it is useful to try to maximise pleasant emotions over the long
term. Openness to emotion is also recognised as being important, because it
permits emotional information to be recognised and coped with, thereby
promoting conditions that foster happiness.

The
health professional will also assess both sexual and nonsexual relational
factors.

Thoughts during sexual interaction

The
health professional may assess the individual’s ability to focus on sexual
stimuli to determine if help is needed. Distractions regarding day-to-day
stresses are common.

Other
distracting feelings include:

Stress;

Resentment;

Sense
of obligation regarding imposed sexual frequency or type of sexual interaction;
and

Prediction
of negative outcome such as unwanted pregnancy, further proof of
infertility, or lack of sexual satisfaction.

Messages from families of origin -
Intergenerational system

Family
of origin factors and intergenerational factors are assessed through the use of
a genogram. A genogram examines different aspects of familial functioning.
Instances of incest, parentification, triangulation and other dysfunctional
patterns of familial relationships that impact intimacy and sexuality will often
need to be assessed.